As you may know, the cervical screening test (a smear test) is designed to identify early changes in some of the cells at the neck of the womb (the cervix).
Why do I have an appointment at the colposcopy clinic?
If these cells are left unattended, they could cause problems at a later stage in your life. Your recent cervical screening test has shown some of these cell changes, which act as an early warning sign that, over time, there is a risk of cervical cancer developing. A colposcopy examination (an examination of your cervix) is the next step in the cervical screening programme.
Can I bring someone with me?
If you are having treatment, you should always try to bring someone with you so that they can take you home after the procedure. If this is not possible, it is recommended that you stay in the clinic until you feel well enough to get a taxi or drive yourself home. You should rest for the rest of the day.
Can I return to work the following day?
You can return to work on the following day as long as it does not involve any heavy lifting or strenuous activity.
What about periods?
If your period has started at the time of your appointment, staff would still like to see you. They will be able to assess your cervix and can often still perform the colposcopy if the bleeding is not too heavy. A follow-up appointment will be arranged, if necessary.
What causes the cell changes/abnormal test result?
This is caused by a virus called the Human Papilloma Virus (HPV), which you could have picked up years ago. It is very common and at least eight out of ten women have the virus at some time.
Fortunately, most women’s bodies reject the virus, but some do not. Smokers are less able to reject the virus. If the virus stays in the cervix for 10-12 years, it can irritate the cells and cause them to change into pre-cancer cells which can lead on to cervical cancer in some women.
What will happen at my appointment?
You will be seen by a colposcopist (a specially trained doctor or specialist nurse who performs a colposcopy – a detailed examination of the cervix, vagina, or vulva using a magnifying instrument called a colposcope) who will ask you some questions. This includes the date of your last period, any contraception use, health problems etc.
You will then be shown into a changing room and, when ready, will have the colposcopy examination. The colposcopist will talk to you about what they see on your cervix and will decide with you what needs to be done.
There are four possible things that might happen during your colposcopy appointment:
- The colposcopist might see no problem at If this happens you will be advised to have a cervical screening test repeated. This can be anything between six months and five years, depending on your particular circumstances.
- The colposcopist might see some very minor changes and will take some These are tiny pinches of skin, which do not need a local anaesthetic. They have no harmful effects but you will be advised to avoid sexual intercourse, use of tampons, and vigorous exercise for two to four days. After this procedure, you can sometimes have a moderate or even heavy vaginal blood loss for up to six days. One in 20 women may also experience some pain which lasts on average for two days. Once the biopsy report comes through, the healthcare professional will write to you and your GP with the results and advice on what to do next.
- The colposcopist might see some abnormal tissue and advise you that this should be The treatment is called Large Loop Excision of the Transformation Zone (LLETZ). This can be done straight away or on another day, this is your choice.
- The colposcopist might see some abnormal tissue and advise you that this requires You may be advised to have this performed under general anaesthetic, but this does not mean the problem is more serious. The area may be difficult to reach or is deeper into the cervix, requiring a bigger biopsy, sometimes called a cone biopsy. If you do need this treatment, staff will aim to offer you a day case appointment within four weeks of the colposcopy appointment.
How do you do the LLETZ treatment?
A fast-acting local anaesthetic will be given into your cervix and once this has taken effect, the colposcopist will use an electrical thin wire loop, which scoops out the abnormal tissue and seals the raw area at the same time to reduce any bleeding. A sticky pad is placed on your thigh before the treatment commences to ensure that the electric current has a safe return path. A suction device is also attached which helps to circulate cool air. This may sound alarming, but the procedure is very safe and usually takes around 10-15 minutes.
What if I have a coil (intra-uterine contraceptive device) in place?
Often the colposcopist is able to perform the LLETZ by pushing the coil threads up and out of the way so that the coil does not have to be removed. Occasionally, this may cause the threads to be cut which may make them difficult to find when the coil needs to be changed.
Alternatively, your coil may be changed at the same time. It may mean that you are referred up to the hospital by your GP Practice if the threads are not visible at the time you want to remove the coil. The coil will then be removed in the outpatient department by a small device with a camera on the end called a hysteroscope.
Is LLETZ treatment painful?
LLETZ is usually painless or minimally uncomfortable because your cervix has been injected with local anaesthetic. Some women experience period type pains for a day or so following the procedure and you are advised to take a simple painkiller if this is the case.
Does LLETZ treatment have any side effects?
LLETZ treatment is generally very safe, but, as with all surgery, there can be complications. Half of all women who have a LLETZ will experience, on average, 10 days of both bleeding and discharge, which could be moderate or heavy. Most women have some pain for, on average, two days after this procedure. If the treated area gets infected, bleeding and pain will continue. The treated area takes around four weeks to heal.
Some women may notice a change in the timing and length of their periods after their colposcopy.
To keep the risk of infection as low as possible, it is recommended that you:
- Avoid sexual intercourse and using tampons for four
- Avoid swimming for four
- Go easy on exercise for two
- Take a shower, rather than soak in a bath for two
If you do get an infection, there will be a smelly discharge or heavy bleeding (heavier than a normal period). You should contact your GP Practice and ask for antibiotics.
In very rare cases, if the bleeding is severe, staff may arrange for you to be admitted to hospital.
Please note: some travel insurance companies will not provide you with health insurance following LLETZ procedure and you are advised you to check with your insurer. You should rearrange your colposcopy treatment appointment if you are going on holiday or flying within one week of the treatment date.
Will treatment affect my chances of getting pregnant?
There is no evidence that treatment to the cervix affects your fertility. A standard size LLETZ treatment (7-10mm deep) may cause shorter pregnancies but does not harm the baby.
Deeper biopsies which are sometimes necessary, or repeat treatments, could increase your chance of preterm labour and delivery.
In normal circumstances, women have a one in 20 risk of preterm delivery (e.g. delivering their baby between 24 and 37 weeks of their pregnancy). A deeper (non-standard) LLETZ may increase that risk to around one in eight.
Your colposcopist will only advise treatment if it is necessary and will be happy to discuss any of these complications with you.
Is there an alternative to LLETZ treatment?
Occasionally, staff can use a high temperature procedure (known as cold coagulation or cervical cautery) to destroy areas on the cervix when the LLETZ procedure is not appropriate. Your healthcare professional will make these decisions about treatment with you.
When and how do I get my results?
Any biopsies are sent to the laboratory for examination and the aim is to send a letter to you and your GP with the results within six weeks of your appointment. Occasionally more treatment is needed, and staff may call you to discuss your options.
What happens next?
For most women (95 out of 100), all that happens is that you will have a follow up cervical screening test in six months. You will then be advised how often you need tests in the future.
For a few women, the problem comes back and you have to have a second treatment. For about three in every 10,000 women, cervical cancer can still develop and that is why it is so important to have your follow-up cervical screening tests.
Rarely will women need to have a hysterectomy. This may be considered if you have other problems such as heavy periods.